Note: This bottom line focuses on therapeutic touch as an energy-based treatment. The following techniques have been excluded: healing touch, Reiki, and Qigong. Research examining the effects of physical touch in general, rather than as part of therapeutic touch, was also excluded.

Therapeutic touch (TT) is a four-step technique developed by Dolores Krieger, RN, PhD, and Dora Kunz in the early 1970s from traditional folk medicine.

TT practitioners make little to no actual physical contact with the person receiving treatment. Instead, they practice the technique by holding their arms at a short distance from the subject. The TT practitioner aims at detecting a person's energy field to fix any imbalances. Nurse Healers Professional Associates, Inc. offers primary training in TT and teaches a standard method. A formal certification course for this therapy is lacking.

There are four basic steps in TT: centering (focusing on the person to help calm them), assessment (detecting imbalances in the person's energy field), intervention (helping to produce a balanced flow of energy into the person's field), and evaluation (confirming and concluding treatment). Treatment sessions typically range from five to 30 minutes.

Several forms of the original treatment have been developed, one of them being healing touch and the Healing Touch Program®, developed by Janet Mentgen, RN in the 1980s. The goal of healing touch is to restore balance and harmony to a person's energy system. Other features of healing touch include empowerment, self-care, and the influence of the relationship between the practitioner and the person being treated.

It has been argued that the concept of TT, that there is a "life energy" or "life force," is a spiritual rather than a scientific principle due to its religious roots. Practitioners have been unable to provide a scientific explanation to support its potential effects, which has made it difficult for scientists to validate TT. But positive results in human trials, encouraging clinical experience, and case reports continue to lend support to the technique.

TT is commonly used in nursing practice for a wide range of health conditions. The strongest evidence supporting the use of TT is in the treatment of pain, anxiety, and stress reduction. There are inconclusive results in the treatment of Alzheimer's dementia, well-being in people with cancer, and wound healing. TT is generally recognized as safe, although its safety has not been proven.

Several studies have been conducted on TT; however, it remains controversial.

Therapeutic touch (TT) is viewed as a holistic therapy (impacting all aspects of health), due to the concept of connection of the human and environmental energy fields.

It has been suggested that practitioners have nine specific qualities if they want to practice TT. These include: an intent to help another, an ability to concentrate, an ability to center, a state of wellness, a feeling of compassion or love, transmission of the environmental energies, effortless effort, an ability of mental visualization, and a sense of confidence.

The "healing triangle" model has been described, establishing three necessary qualities for both providers and subjects to possess. These include patience, which combines perseverance, humility, and concentration; intention, in which subjects determine their will to get well; and imagination, which is a combination of the first two characteristics.

Subjects have described their TT experience as enhancing physical, mental or emotional self-awareness. The effects experienced after the treatment could be categorized into physical, mental or emotional, and spiritual effects.

TT practitioners make little to no actual physical contact with the subject. Practitioners typically hold their arms at a short distance from the subject, although they may physically place their hands on the subject's head, shoulders, or feet at the beginning and end of the treatment. The TT practitioner aims to detect a person's energy field and to fix any imbalances in it.

There are four basic steps in TT: (1) centering (focusing on the person to help calm them), (2) assessment (detecting imbalances in the person's energy field), (3) intervention (helping to produce a balanced flow of energy into the person's field), and (4) evaluation (confirming and concluding treatment). Treatment sessions range from five to 30 minutes.

In adults, TT has been given in single or multiple treatment sessions, lasting 3-50 minutes each. TT has been used 1-2 times daily, once to several times weekly, or once monthly, for up to 15 weeks.

In children, TT has been given in single or multiple treatment sessions, lasting 5-60 minutes each. TT has been used daily for three days or three times weekly.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

There is some evidence to suggest that therapeutic touch (TT) may reduce anxiety and stress in adults with heart disease and mental illness. Some studies showed improvement in anxiety in healthy people. Other trials found that TT may lack benefit on pre-surgery anxiety in people with heart disease, and on pre- and post-surgery anxiety in people with breast cancer. However, the quality of these studies is questionable. Other research found that TT lacked benefit in reducing anxiety and pain in women undergoing procedures such as breast biopsy (removal of breast tissue). Further research on the usefulness of TT in anxiety disorders is needed.

B

Much research has been done on the use of energy therapies, including TT, for pain management. TT has demonstrated some benefits in reducing pain associated with surgery, burns, cancer, and arthritis. Although early evidence is promising, many studies on TT are of low quality. More high-quality research is needed to confirm findings.

B

Research has shown that TT may reduce stress response in children and adults. However, research in this area is inconsistent. Some studies found a lack of evidence of benefit that TT reduces anxiety in students. More high-quality studies are needed to confirm the effectiveness of TT for stress.

B

Many complementary and alternative medicines have been studied for the management of arthritis. Early research suggests that TT may benefit people with arthritis by reducing pain and improving hand function. However, overall evidence is weak, particularly for osteoarthritis. More research is needed before a firm conclusion can be made.

C

Early research found that TT was similar to placebo in the treatment of carpal tunnel syndrome in terms of muscle response, pain, and relaxation. More high-quality studies are needed before a conclusion can be made in this area.

C

Studies suggest that TT may benefit people with dementia. TT may reduce screaming or shouting behaviors, anxiety, and aggression, as well as promote relaxation. Research has found that massage and touch may treat conditions such as agitation, anxiety, and depression in dementia. Although promising, further high-quality research is needed in this area before any firm conclusions can be made.

C

Early research evaluating the effects of TT in type 1 diabetes has found a lack of evidence of benefit. Further study is needed before a conclusion can be made.

C

Fibromyalgia is a chronic pain disorder that affects joints, muscles, and tendons, and has no definite treatment. Complementary therapies, including TT, have been used to help relieve pain. Early evidence shows that TT may reduce pain and improve quality of life in people with fibromyalgia. Further study is needed before a conclusion can be made.

C

Early study suggests that TT may produce a medium effect on physical and mental outcomes in people with headache. Early research suggests that TT may reduce tension headache pain. More research is needed to confirm the effectiveness of TT for headaches.

C

There is a lack of evidence to support the use of TT as a treatment for high blood pressure. Early research reviewed the effect of "laying on of hands" and found a decrease in blood pressure, which was attributed to the placebo effect of the study. Further study is needed before conclusions can be made for or against the use of TT in high blood pressure.

C

There is a lack of evidence to support the use of TT as a treatment for HIV/AIDS. More research is needed on the use of TT before conclusions can be made.

C

TT has been suggested to promote the flow of breast milk. However, early evidence has lacked significant results. More research is needed before a conclusion can be made.

C

TT has shown benefit in premature babies. In hospitalized newborns, TT reduced post-birth complications and decreased the average length of stay in the hospital. TT-trained nurses have also reported lower heart rate, improvements in breathing, sucking, and swallowing, and increased ability to rest and engage with the environment. More high-quality research in this area is needed to confirm these early findings.

C

Early evidence suggests that TT may benefit children with mental disorders. Hospitalized adolescents were able to communicate better and feel relaxed after therapy. However, more high-quality research is needed before a conclusion can be made.

C

There is a lack of strong evidence to support the use of TT as an additional therapy with rehabilitation. Although early results are promising, more studies are necessary before any specific conclusions can be made.

C

Researchers suggest that energy-based techniques may help promote relaxation. Early study suggests that TT may promote relaxation in people in pain. High-quality studies are needed before a conclusion can be made.

C

Early research has found inconsistent results on the use of TT for people who have had surgery. Benefits have included reduced pain and cortisol (a marker of stress), although a lack of benefit has also been observed for complications and mortality. Further high-quality research is needed in this area before any firm conclusions can be made.

C

Early research suggests that TT may benefit people with cancer in terms of reducing pain and anxiety, improving well-being, and reducing side effects of chemotherapy. However, available research is low in quality. Further study is needed before a firm conclusion can be made in this area.

C

Studies have found mixed results with respect to TT for wound healing. Some research suggests that TT may promote wound healing, while others found that TT lacked effect on healing. Further research is needed in this area.

C

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Safety
Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Therapeutic touch (TT) is generally safe for most people. It is believed that the sessions need to be shorter in children and that the technique should not be used to replace proven therapies to treat potentially serious conditions. TT is likely safe when given by a trained practitioner.

Use cautiously in people taking depressants, as TT may cause added sedation.

TT may cause low blood pressure. Caution is advised in people taking drugs or herbs and supplements that lower blood pressure.

Use cautiously in people with autoimmune disorders or those taking agents that affect the immune system. TT may affect white blood cell levels.

Use cautiously in people with fever or inflammation. TT may send "life force" into an already weakened person.

Use cautiously when TT is given by a practitioner who is upset or ill, as this may transfer to the subject.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.